Section 210-RICR-30-05-3.14 - Non-custodial Parents with TPLA. Medicaid is always the payer of last resort. Accordingly, EOHHS considers all other health insurance or coverage provided to a Medicaid-eligible individual as third-party liability (TPL) coverage. EOHHS reserves the right to disenroll Medicaid beneficiaries with TPL from Medicaid managed care and enroll them in RIte Share. This is called RIte Share Zero Premium. 1. TPL coverage through the non-custodial parent - Children who are enrolled in both Medicaid managed care and also have access to coverage through a non-custodial parent (NCP), will be transitioned into RIte Share Zero Premium unless the custodial parent shows good cause for not making the transition. The child will retain access to all applicable Medicaid covered services the entire time that they are in RIte Share Zero Premium. Should the NCP lose their ESI, the RIte Share Unit must be notified at least ten (10) days prior to the child's disenrollment to meet established reporting requirements and assure the child is transitioned back into Medicaid managed care without coverage gaps.2. Custodial parent non-compliance - If the custodial parent refuses to allow the child to be enrolled in the NCP's coverage, the custodial parent's Medicaid eligibility is terminated until the custodial parent complies with the RIte Share participation requirement. Good cause exemptions to RIte Share are permitted under § 3.23 of this Part.3. Notice and enrollment - Medicaid beneficiaries must be provided with notice from EOHHS explaining their rights and responsibilities including: a. RIte Share participation. The requirement to participate in RIte Share is a condition of continuing Medicaid eligibility for adults in the household. The Medicaid member with TPL must receive the notice fourteen (14) or thirty (30) days, as appropriate (see § 3.12 of this Part), prior to the required transition from a Medicaid managed care plan.b. Grace period. Parents/caretakers are given a fourteen (14) day grace period to report any changes in the NCP's coverage and/or report any difficulties with using the NCP's coverage.c. Failure to respond. If the parent/caretaker does not respond, the Medicaid beneficiaries who are covered under the NCP's policy will be transitioned from Medicaid managed care to RIte Share, and sent appropriate documentation. Those household members who are not covered under the NCP's coverage (such as a custodial mom, children not related to the NCP, etc.) will remain in Medicaid managed care.d. Cost-sharing. The notification must indicate clearly that EOHHS is not responsible for coinsurance, cost sharing obligations, or wraparound coverage for the NCP or any other Medicaid-ineligible family members210 R.I. Code R. 210-RICR-30-05-3.14
Amended effective 8/6/2019